Bone mineral density and importance of a gluten-free diet in patients withceliac disease in childhood

Objectives. Celiac disease (CD), a common cause of malabsorption, is known to be associated with disorders of the skeleton, but there are conflicting data about the effect of diet on bone metabolism. The aims of this study we re to investigate the prevalence of osteopenia; to identify the relationshi p between bone mineral density (BMD), serum calcium, and parathyroid hormon e levels; and to determine the effect of gluten-free diet on BMD in childre n with celiac disease. Design. The study included 32 patients with CD (group 1) and 82 healthy con trols (group 2). The patients with CD were evaluated under 2 subgroups, ie, 16 patients with recent diagnosis (group 1a) and 16 patients who follow th eir diet strictly (group 1b). BMD values and concentrations of calcium, pho sphorus, alkaline phosphatase, and intact parathyroid hormone were determin ed on entry to the study and at 12 months in celiac patients. These values were compared with those of healthy control participants. Results. BMD and bone mineral content values in patients with recent diagno sis were found to be significantly lower than the control group. The BMD va lues in patients with recent diagnosis were significantly increased after a gluten-free diet for 1 year. Osteopenia was found more commonly in patient s with recent diagnosis than patients in whom a gluten-free diet had been i nstituted. At 1-year follow-up, osteopenia was not resolved with the gluten -free diet, and this was especially true in patients without gastrointestin al manifestation. In patients with recent diagnosis (group 1a), the mean ca lcium level was found to be lower than the patients who follow their diet s trictly (group 1b). There was a positive correlation between calcium level and BMD and bone mineral content. Conclusions. BMD is almost invariably low in newly diagnosed celiac patient s in childhood. We therefore recommend that BMD should be evaluated in pati ents with CD. Strict gluten avoidance promoted a significant increase in BM D. However, values still remained markedly low after 1 year of follow-up in some patients. These patients should be followed for longer periods of tim e with yearly BMD evaluation, as 1 year of diet therapy was found to be ins ufficient for osteopenia to be resolved.